一位面臨血液透析抉擇病人的護理經驗

Nursing Experience of Patient Facing First Hemodialysis

林小閔(Shiau-Min Lin)；李佳倫(Chia-Lun Lee)

血液透析抉擇 ； 末期腎病 ； choice of hemodialysis ； end stage renal disease

嘉基護理

15卷1期（2015 / 06 / 01）

19 - 27

繁體中文

本文藉由照護一位中年男性面臨末期腎病的經驗，討論初次接受血液透析治療引起之心理、生理及社會問題。護理期間自2011年8月31日～2011年9月7日，筆者運用觀察、會談、身體評估及病歷查閱等方式收集資料，發現個案之健康問題如下，體液容積過量：與腎臟調節水份機轉失調及攝水知識不足有關、焦慮：與擔心動靜脈瘻管手術及後續就醫問題有關、潛在危險性感染：與右頸暫時性雙腔導管留置及缺乏導管照護知識有關。筆者先評估個案需求，依據學理教導平日如何攝取水份及避免水分滯留，指導個案利用觸覺及聽覺自行評估動靜脈瘻管功能並回覆示教，藉由提供良好的醫療支持系統減輕其內心焦慮，也透過持續及個別性的護理衛教，使個案了解導管留置目的及照護方式，進而維持正常社交活動並接受血液透析治療。

This paper discusses the psychological, physical and social issues in ESRD patients facing choice of hemodialysis from the care experience of a middle-aged male ESRD patient. The care period was from August 31^(th) to September 7^(th), 2011. Through collecting all the information from observation, interview, physical assessment and medical records review, the following health problems were found. First problem was ＂Fluid overload＂ that was because of inappropriate water excretion after kidney failure and inadequate knowledge of the water intake and balance in kidney failure status. The second problem was ＂Anxiety＂ and this problem was due to fear of arteriovenous fistula surgery and medical follow-up in the future. The last problem was ＂Risk of infection＂ which was related to double lumen catheter and lack of care ability by himself. The author evaluated the need of the patient first, and taught him how to drink water during a day and prevent water retention. Furthermore, the patient learned and practiced the skills about functional assessment of arteriovenous fistula by tactile and hearing sense from the author. After the above effort, this patient's anxiety was decreased because of good medical supporting systems. Through continuous and individualized care and health education, patient could understand the purpose and care of the catheter, maintain social activities, and receive hemodialysis treatment regularly.

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